Repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap
10.3760/cma.j.cn114453-20190119-00014
- VernacularTitle:B形第一掌背皮神经营养血管皮瓣修复拇指末节脱套伤
- Author:
Hongjie XU
1
;
Xiaohang ZHAO
;
Defeng HU
;
Yi SUN
;
Jian’an MA
;
Zhenye HU
;
Shunjiang ZHENG
;
Yongsong CHENG
Author Information
1. 浙江省永康市骨科医院手外科 321300
- Keywords:
Thumb;
Surgical flap;
Skin transplantation;
Microsurgery
- From:
Chinese Journal of Plastic Surgery
2020;36(6):660-663
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical effect of repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap.Methods:The clinical data included 15 patients with distal thumb degloving injury received in Yongkang Orthopedic Hospital from March 2015 to June 2018. These patients included 10 males and 5 females, aged between 24 and 61 years. For the injury, 7 cases were beyond the interphalangeal joint, 8 cases were beyond the nail root. The length of the distal segment of degloving finger was 1.8 to 2.3 cm, and the skin and soft tissue defect ranged from 1.8 cm × 4.6 cm to 2.3 cm × 5.6 cm. The distal thumb degloving injury was repaired with B-shaped first palmar dorsal neurocutaneous vascular flap. The radial dorsal metacarpal nerve of the first metacarpal was anastomosed with the ulnar proper digital nerve stump. And full-thickness skin graft transplantation was performed in donor area. After the operation, the shape and function of the thumb were followed up. The sensory function of the skin was determined by British Medical Research Association Sensory Function Evaluation Standard, and the function of the thumb was evaluated with reference to the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:The flap area was 2.0 cm × 5.0 cm-2.5 cm × 6.0 cm, and all the flaps were survived. Follow-up period was 5-18 months after the operation, with an average of 10 months. The flap at the thumb repair site was soft, wear-resistant, non-bloated, no obvious pigmentation. Its protective sensation was restored. The two-point discrimination of the flap reached 8-11 mm, with an average of 9.3 mm, basically restoring the original shape and function of the thumb. There were 13 cases reaching the S3 + flap sensory function, 2 cases reaching S3. The thumb function was evaluated as excellent for 9 cases, and good for 6 cases. There were no complications such as scar contracture and hypersensitivity in the donor area. Conclusions:The repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap can complete skin coverage and sensory reconstruction, with satisfactory postoperative effect.
